Maternal breastfeeding: indicators and factors associated with exclusive breastfeeding in a subnormal urban cluster assisted by the Family Health Strategy

Silva, Vera A.A.L.; Caminha, Maria F.C.; Silva, Suzana L.; Serva, Vilneide M.S.B.D.; Azevedo, Pedro T.A.C.C.; Batista, Malaquias

doi:10.1016/j.jped.2018.01.004

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Original articles • J. Pediatr. (Rio J.) 95 (3) • May-Jun 2019 • https://doi.org/10.1016/j.jped.2018.01.004 copy

Maternal breastfeeding: indicators and factors associated with exclusive breastfeeding in a subnormal urban cluster assisted by the Family Health Strategy^☆ ☆ Please cite this article as: Silva VA, Caminha MF, Silva SL, Serva VM, Azevedo PT, Batista Filho M. Maternal breastfeeding: indicators and factors associated with exclusive breastfeeding in a subnormal urban cluster assisted by the Family Health Strategy. J Pediatr (Rio J). 2019;95:298 -305.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To describe and analyze indicators of feeding practices related to breastfeeding and factors associated with exclusive breastfeeding (EBF) in a subnormal urban cluster (slums) in Pernambuco, Brazil.

Methods:

Four breastfeeding indicators were used to interview mothers of children under 3 years of age. An inventory of the families' socioeconomic and environmental factors, maternal obstetric history, and basic health care access was undertaken. The sample consisted of all 310 children under the age of 3 years from Coelhos, PE, Brazil. Spearman's correlation was carried out, as well as crude and adjusted prevalence ratios for a final statistical model that showed associated factors with the main outcome at a level of 0.05.

Results:

The prevalence of breastfeeding in the first hour of life, exclusive breastfeeding up to 6 months, continued breastfeeding at 1 year, and continued breastfeeding at 2 years were 60.2%, 32.9%, 45.9, and 35.9%, respectively. A correlation was observed between start of pacifier use and duration of either exclusive (r _s = 0.358 [p < 0.001]) or non‐exclusive breastfeeding (r _s = 0.248 [p = 0.006]). Maternal age over 35 years (p < 0.001), home visit in the first week after birth (p = 0.003), having had a male baby (p = 0.029), and not using a pacifier (p < 0.001) remained protective factors in the final model.

Conclusion:

The prevalence rates of exclusive breastfeeding at 6 months were well above the results obtained by other Brazilian authors. Home visit and maternal age prevailed as protective factors, while pacifier use was shown to be a discouraging practice.

KEYWORDS
Breastfeeding; Primary health care; Pacifiers; Cross-sectional studies; Risk factors

Variables	Sample^a a Sample varied due to lack of information for some items (does not know, does not remember). n = 219	EBF ≥ 6 months n = 72 (%)	Crude PR (95% CI)	p-value^b b Poisson.
Time living in a slum				0.0724
<10 years	44	9 (20.4)	0.57 (0.31 -1.05)
10 years or more	175	63 (36.0)	1
Maternal age				0.0033
13 -19 years	33	7 (21.0)	0.36 (0.17 -0.76)
20 -35 years	164	52 (31.7)	0.54 (0.35 -0.81)
≥36 years	22	13 (59.1)	1
Ethnicity				0.6938
White	44	12 (27.3)	0.79 (0.43 -1.45)
Black	55	19 (34.5)	1
Mixed-race/Asian	120	41 (34.2)	0.99 (0.64 -1.54)
Marital status				0.3162
Single	71	20 (28.2)	0.80 (0.52 -1.23)
Married/with partner	148	52 (35.1)	1
Maternal employment				0.4661
Homemaker	91	34 (37.4)	1
Regularly employed/Self-employed	57	16 (28.1)	0.75 (0.46 -1.23)
Others^c c Others: student, unemployed, looking for work, employed without a formal contract, eventual work, retired, inmate.	71	22 (31.0)	0.83 (0.53 -1.28)
Maternal level of schooling				0.3202
<8 years of schooling	135	48 (35.6)	1
≥8 years of schooling	83	24 (28.9)	0.81 (0.54 -1.22)
Social class ^d d A = R$ 11,037.00, B1 = R$ 6006.00, B2 = R$ 3118.00, C1 = R$ 1865.00, C2 = R$ 1277.00, DE = R$ 895.00.				0.3424
B1 and B2	11	2 (18.2)	0.54 (0.15 -1.92)
C1, C2, DE	208	70 (33.7)	1
Homeowner				0.4127
Yes	145	45 (31.0)	0.85 (0.58 -1.25)
No	74	27 (36.5)	1
Type of household				0.1878
House/apartment	175	54 (30.9)	0.75 (0.49 -1.15)
Room/shack/stilt house	44	18 (40.9)	1
Water supply through the general water network system with internal piping				0.3303
Yes	161	50 (31.1)	0.82 (0.55 -1.22)
No	58	22 (37.9)	1
Waste disposal system (condominium network)				0.1112
Yes	132	38 (28.8)	0.74 (0.50 -1.07)
No	87	34 (39.1)	1

Variables	Sample^a a Sample varied due to lack of information for some items (does not know, does not remember). n = 219	EBF ≥ 6 months n (%)	Crude PR (95% CI)	p-value^b b Poisson.
Prenatal care started in the first trimeste r				0.1701
Yes	144	43 (29.9)	0.75 (0.50 -1.13)
No	58	23 (39.7)	1
Number of prenatal consultations				0.4453
≤3	11	2 (18.2)	0.44 (0.11 -1.72)
4 -5 consultations	22	9 (40.9)	1
6 or more	168	54 (32.1)	0.78 (0.45 -1.36)
Breasts were examined during prenatal				0.5632
Yes	181	58 (32.0)	0.84 (0.47 -1.51)
No	21	8 (38.1)	1
Received guidance on breastfeeding during prenatal care				0.3464
Yes	191	64 (33.5)	1
No	11	2 (18.2)	0.54 (1.15 -1.94)
Type of delivery				0.1551
Vaginal	134	49 (36.6)	1
C-section	85	23 (27.1)	0.74 (0.49 -1.12)
Prematurity				0.2795
Yes	12	2 (16.7)	0.49 (1.37 -1.78)
No	207	70 (33.8)	1
Gender				0.1178
Male	111	42 (37.8)	1
Female	108	30 (27.8)	0.73 (0.50 -1.08)
Birth weight				0.9058
<2500	20	7 (35.0)	1
≥2500	187	63 (33.7)	0.96 (0.51 -1.81)
Skin-to-skin contact in the delivery room				0.4395
Yes	172	55 (33.0)	0.84 (0.54 -1.31)
No	42	16 (38.0)	1
Received home visit after being discharged from maternity hospital				0.0043
Yes	128	52 (40.6)	1
No	87	18 (20.7)	0.51 (0.32 -0.81)
Pacifier use				<0.0001
Yes	102	16 (15.7)	0.33 (0.20 -0.53)
No	117	56 (47.9)	1

Variables	Adjusted PR (95% CI)	p value^a a Poisson.
Time living in the slum		0.095
<10 years	0.61 (0.34 -1.09)
10 years or more	1
Maternal age (years)		<0.001
13 -19	0.35 (0.17 -0.74)
20 -35	0.52 (0.36 -0.75)
≥36	1
Type of household		0.887
House/apartment	1.04 (0.62 -1.73)
Room/shack/stilt house	1
Waste disposal system (condominium network)		0.320
Yes	0.84 (0.60 -1.18)
No	1
Prenatal care started in the first trimester		0.833
Yes	1.05 (0.68 -1.62)
No	1
Type of delivery		0.191
Vaginal	1
C-section	0.77 (0.52 -1.38)
Gender		0.029
Male	1
Female	0.67 (0.47 -0.96)
Received home visit after being discharged from the maternity hospital		0.003
Yes	1
No	0.52 (0.34 -0.80)
Pacifier use		<0.001
Yes	0.37 (0.23 -0.60)
No	1

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[1] * Corresponding author. E-mail:suzanalinsilva@gmail.com (S.L. Silva).